Women's Health: Clinical Pearls with Emma Sutherland

In celebration of International Women’s Day, our ambassador Emma Sutherland revisits several of our recent podcasts featuring leading women practitioners and highlights the key clinical pearls that focus on supporting the health of the women in our lives. 

Emma highlights the importance of taking a detailed case history and not to overlook any signs a clients may present with based on the podcast Dr Michelle Woolhouse and Professor Cassandra Szoeke recorded on the Women’s Healthy Ageing Study. The risks associated with untreated menopausal symptoms can lead to increased cardiovascular and bone density loss risks that cannot be overlooked. Emma emphasises the importance of meaning and purpose in the menopausal period and the connection it has to health for women. 

Revisiting Rhiannon Hardingham’s podcast on interpreting hormone pathology, Emma discusses DHEA testing for adrenal function and chronic stress identification and shares some excellent tips on how to support the restoration of these critical processes. Oestrogen dominance is discussed widely at the moment, and Emma clarifies how to quantify this diagnosis with your client and when the use of Vitex is warranted, or not. 

Dr. Nicola Gates’ podcast on menopause, oestrogen and the brain is an incredible deepdive into the role oestrogen has on the brain - who knew that oestrogen was so important for brain function! Emma recaps the role of oestriol, oestradiol and oestrone and their functions and the way they impact the busy multi-tasking brain and covers the role a reduced oestrogen level post-menopausal has on memory retrieval.  

Covered in this episode

[00:39] International Women’s Day and women’s health
[01:36] Pearls from Let’s Talk HRT: The Secrets of the Women’s Healthy Ageing Study with Dr. Michelle Woolhouse and Professor Cassandra Szoeke
[05:00] Pearls from Interpreting Pathology: Hormones Beyond Fertility and Reproduction with Emma Sutherland and Rhiannon Hardingham
[08:11] Pearls from Menopause: Oestrogen and the Brain with Emma Sutherland and Dr. Nicola Gates

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Key takeaways 

• FX Medicine is committed to breaking the bias and looks forward to a gender equal world in the future. 
• FX Medicine appreciates the diversity of our team, audience and their clients and celebrates these differences. 
• FX Medicine is driven to support women in practice.  
• DHEA testing supports the identification of adrenal dysfunction generally due to chronic stress. 
• How to quantify an oestrogen dominance diagnosis. 
• The role of oestriol, oestradiol and oestrone and their functions and the way they impact the busy multitasking brain. 
• Reduced oestrogen levels post-menopausal impacts memory retrieval and may be confused with memory loss. 

Podcasts discussed in this episode

• Let’s Talk HRT: The Secrets of the Women’s Healthy Ageing Study with Dr. Michelle Woolhouse and Professor Cassandra Szoeke
• Interpreting Pathology: Hormones Beyond Fertility and Reproduction with Emma Sutherland and Rhiannon Hardingham
• Menopause: Oestrogen and the Brain with Emma Sutherland and Dr. Nicola Gates

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Transcript

Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Emma Sutherland.  

International Women's Day is a global holiday celebrated annually on March the 8th to commemorate the achievements of women and this year’s theme is ‘Break the Bias’.  

 As a passionate advocate for Women’s Health, I am marking this International Women’s Day by spotlighting some of the excellent Women’s Health focused podcasts my colleagues and I here at FX Medicine have released over the last few months. Sometimes with so much great content out there, it’s hard to zero in on what the key take outs are. By sharing mine, I really hope you’ll learn something new and find additional ways to support women’s health in your practice.  

Here are the clinical practice pearls from my top women’s health podcasts so far…  

The first of our clinical pearls come from the episode Let’s Talk HRT: The Secrets of the Women’s Healthy Ageing Study with Dr. Michelle Woolhouse and Professor Cassandra Szoeke.  

One of my key clinical pearls from this podcast is the importance of a detailed case history in clinical practice, particularly for women's health. As practitioners, it is so important that we take note of the signs and symptoms of our female clients and undertake an informed risk profile when developing a treatment plan, particularly when as you know, historically women had their symptoms brushed off as being hysterical and were often not treated.  

From a practitioner’s perspective, it blows my mind to think that up until 2016, all medical testing was done on male lab rats. This was due to the complexity and variable nature of women's health, the inability to control these variables, and how this may have impacted the outcomes for women’s health. There is still so much that we can learn from the case taking process - it is such a critical part of the consultation. The other thing I find about it is ,that it is cathartic for women to be heard.  

My second clinical pearl from Professor Cassandra Szeoke is the importance of treating the signs of the menopausal transition, including the common hot flushes. Hot flushes are so often ignored, with women grinning and bearing them without treatment and increasing their risk of heart disease risk - women often tend to downplay their symptoms! We also know that severity of menopausal symptoms such as hot flushes is strongly associated with an increased risk of cardiovascular disease and a reduction of health later in life. Heart disease is the second leading cause of death in women in Australia, and cerebrovascular disease is the third, so being able to gauge these symptoms as practitioners and respond is so important.  

Finally, my last pearl for this episode was at the end of the episode where Cassandra gave us her healthy ageing tips and the one that stood out the most to me was when she was talking about meaning and purpose and connection to community and really how essential it is for our quality of life. I really loved this advice and that Cassandra also pointed out that meaning and purpose doesn’t have to a big thing; rather it’s just the ability to identify those things and people that make you want to get out of bed in the morning. I mean, when I look at Sophia’s happy smiling face, it really makes me want to get out of bed. When I get emails from patients that are doing well, it really makes me want to get out of bed. So it’s about finding that meaning and purpose for yourself. 

To summarize again: Make sure to assess menopausal symptom severity and take a thorough case history, and talk to your patients about meaning and purpose in their lives at all stages but particularly as they get older.  

My next set of clinical pearls come from the podcast that I did with Rhiannon Hardingham called Interpreting Pathology: Hormones Beyond Fertility and Reproduction.  

There was so much I learnt from this podcast, but let’s take DHEA, one of my all-time favourite hormones. It’s important to test this, as it’s a reflection of a woman’s adrenal resilience and her chronic stress levels. This is so useful in clinic to test. Look, it’s a hormone produced by the adrenals and then it’s converted across into testosterone. Low levels correlate to the chronic stress picture and this progressive wear and tear on a woman’s body. Working on improving levels of DHEA is absolutely critical. Rhiannon’s key herb of choice here is Tribulus taken daily for three months.  

My next clinical pearl also came from the podcast with Rhiannon was about oestrogen dominance. Now the gold standard assessment for oestrogen dominance is two well-timed female blood hormone panels: the first is on day 2 or 3 of the menstrual cycle, and the second 7 days after ovulation, during that peak luteal phase. So, we are looking for oestradiol to be around 100 to 200 on day 2 to 3, and then around 600 to 700 during the luteal phase. If a woman has an oestradiol level over 700 for example, and her progesterone on the same peak luteal blood test is under 60, and she’s exhibiting symptoms of oestrogen dominance, then – and only then – can you say that she is oestrogen dominant. So, let’s drop using this phrase unless we have clinical evidence for it with two well-timed blood tests.  

Another fantastic pearl from this episode was what I call the “great Vitex debate.” Now, I bet this confuses so many clinicians out there. You use Vitex when you have a low oestrogen or low progesterone status. So, for example, premature ovarian insufficiency. Rhiannon also reminded us to think about steroidal saponin based herbs like Shatavari, Dong Quai and Black Cohosh, for these low oestrogen states.  

And conversely, when do you not use vitex? You don’t use it if there is any evidence of oestrogen dominance, such as endometriosis or PCOS. The outcomes of prescribing vitex in situations like this could mean an exacerbation of symptoms such as heavy periods, sore breasts, irritability, and I know from experience, you will have a very cranky patient. So please ensure that you test for oestrogen dominance before you use Vitex.  

My final set of clinical pearls comes from the podcast that I did with Dr. Nicola Gates, Menopause: Oestrogen and the Brain. The importance of oestrogen in the brain is unbelievable, I had no idea. It’s used in oxygen metabolism in the brain and did you know that there are more oestrogen receptors in that prefrontal cortex than anywhere else in the brain? I didn’t know that. And now this is the region involved in reasoning, problem solving, impulse control, and creativity. So, the brain actually makes its own oestrogen in the hypothalamus, it doesn’t simply use systemic oestrogen. That show us how important oestrogen is for brain function. 

My next little pearl is about what I call the “multitask dilemma.” The type of oestrogen we are producing impacts how our brain functions, and a great example of this is during pregnancy. So just to recap and remind you, oestradiol or E2, is the most common type of oestrogen in women of child bearing age and it’s the strongest one. Then we have estriol or E3, the main oestrogen produced during pregnancy, and finally oestrone, or E1, the only oestrogen your body makes after menopause. And that’s the weakest form of oestrogen.  

Now due to changes in the type of oestrogen produced during pregnancy, we become better at toggling  between tasks – that was Nicola’s phrase: toggling – which sort of sets us up for parenthood, I guess. But in modern day women, this toggling pattern means a woman thinks she can multitask but she’s simply overburdening herself with mental load. Now you would see this clinically all the time, I am sure. So just remind your patient of the different forms of oestrogen and how they work in the brain.  

The next one that Nicola brought up is “Do I have dementia?” Now when the brain is adjusting to lower oestrogen levels in menopause, it becomes not only harder to form memories but actually to retrieve them as well. It’s critical to reassure women who think “Have I got dementia? I’m only 55 years of age.” You need to tell her “You are forming those memories, it’s that the change in oestrogen levels causing a change in the enzyme that helps you retrieve that memory and that’s why you're forgetting things. Just remind your patient that this is temporary and that will pass once her brain adjusts to those lower oestrogen levels. So as Dr. Nicola Gates reaffirmed, it is a temporary situation.  

I hope you’ve enjoyed my key takeaways and practice pearls from some of our most recent episodes. Now I’d really like to hear from you. What’s your best piece of health advice for women? You can let us know on FX Medicine’s Facebook or Instagram accounts, or you can email us at [email protected]  

Thanks so much for listening and don’t forget you can find all the episodes that I discussed today, along with show notes, transcripts, all the research and resources from all these episodes on our website – fxmedicine.com.au. I’m Emma Sutherland and on behalf of the entire FX Medicine team, Happy International Women’s Day. We’ll see you next week with a brand-new podcast.  

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